The scenario below is about a process that resulted in a safety event. Think about an improvement idea that can fix the problem. Cheryl Rose could tell something was wrong when she last picked up her daughter Haileys medication. Hailey has epilepsy, and for 13 years she has taken a number of prescriptions to keep her seizures at bay. But when Rose last picked up her medication from a Shoppers Drug Mart in Surrey, BC she found that there was double the daily dose of one pill and another was missing altogether. Is it my job to double check everything your pharmacist does? As a parent I do, but this is unacceptable, she told Global News. Shoppers Drug Mart wouldnt comment, but a pharmacist told Global News that shes reviewing the case with staff. There were 28 cases of medication-related mistakes reported in B.C. in 2017. Such mistakes are the second-most common complaint received by the College of Pharmacists of British Columbia. We will investigate to try to find out what happened in that situation, said Bob Nakagawa, the colleges registrar. And if theres a systematic issue that needs to be addressed, to try to make sure we can take steps to prevent that from happening again in the future. In the meantime, Rose noted that her daughters prescription was labelled correctly, but she still wants to find out why she received the wrong pills. She wants standards set higher immediately.

B) This is a case of an ______________.*

1 point

A) This is a case of a wrong _____________ event....*

1 point

Why did the person get incorrect dose?*

1 point

Process Issues with Pharmacy

Burnout of staff

Scheduling issue with booking staff

Covid-19

Printer issues

The person got ___________ dose*